Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1386992758 |
---|---|
Provider Name | Breno T Rodrigues |
First Address | Sandy, UT 84094-3793 |
Second Address | Sandy, UT 84094-3762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2012 |
Last Update Date | 22/11/2021 |